IHEAn Introduction for Source Atlantic

IHEAn Introduction for Source Atlantic

IHE PCD: Simplify Specs!IHE PCD: Simplify Specs!

IHEIHE

• International organization of manufacturers, standards organizations, and users– IHE is not a standard, IHE is a user of standards

• Identify and constrain standards to make them more user friendly and truly interoperable– Saying it’s a compliant IHE Image Acquisition Actor means a lot

more than saying its “DICOM”– Claiming a Central Station is a Device Observation Reporter

(DOR) means more than saying its HL7• Standards are broadly based while IHE drills down to specify the

parts of standards that are normally ambiguous– Example: A medical device claiming to be a DOR must use HL7

v2.6 and must structure their HL7 messages in a way clearly defined by IHE, using message content and semantics that is also clearly defined by IHE

• Vendors test their connectivity at annual connectathons

• International organization of manufacturers, standards organizations, and users– IHE is not a standard, IHE is a user of standards

• Identify and constrain standards to make them more user friendly and truly interoperable– Saying it’s a compliant IHE Image Acquisition Actor means a lot

more than saying its “DICOM”– Claiming a Central Station is a Device Observation Reporter

(DOR) means more than saying its HL7• Standards are broadly based while IHE drills down to specify the

parts of standards that are normally ambiguous– Example: A medical device claiming to be a DOR must use HL7

v2.6 and must structure their HL7 messages in a way clearly defined by IHE, using message content and semantics that is also clearly defined by IHE

• Vendors test their connectivity at annual connectathons

Why Specify IHEWhy Specify IHE

• Specifying integration requirements for the system you are purchasing is a simple matter of selecting which IHE Integration Profiles and which IHE Actors you want supported

• When you tell a vendor you want a certain IHE actor they immediately know your interface specifications instead of requiring an extensive interface technical assessment

• Users can concentrate on the clinical requirements of their equipment – not how it is going to interface to other systems

• Removes custom interfaces as obstacles for future upgrades and additions

• Specifying integration requirements for the system you are purchasing is a simple matter of selecting which IHE Integration Profiles and which IHE Actors you want supported

• When you tell a vendor you want a certain IHE actor they immediately know your interface specifications instead of requiring an extensive interface technical assessment

• Users can concentrate on the clinical requirements of their equipment – not how it is going to interface to other systems

• Removes custom interfaces as obstacles for future upgrades and additions

IHE Technical FrameworksIHE Technical Frameworks

• Profiles– Describe clinical information management use cases

and specify how to use existing standards (HL7, DICOM, IEEE 11073, etc,...) to address them.

• Actors– A system or application responsible for certain

information or tasks. Each Actor supports a specific set of IHE transactions to communicate with other Actors.

• Transactions– An exchange of information between Actors. For each

transaction a Technical Framework describes how to use an established standard (such as HL7, DICOM or W3C) to exchange information.

• Profiles– Describe clinical information management use cases

and specify how to use existing standards (HL7, DICOM, IEEE 11073, etc,...) to address them.

• Actors– A system or application responsible for certain

information or tasks. Each Actor supports a specific set of IHE transactions to communicate with other Actors.

• Transactions– An exchange of information between Actors. For each

transaction a Technical Framework describes how to use an established standard (such as HL7, DICOM or W3C) to exchange information.

IHE ProfileIHE Profile

AR

PCD-04 Report Alarm

AM

PCD-06 Disseminate Alarm

AC

PCD-05 Report Alarm Status

PCD-07 Report Dissemination Alarm Status

PCD-05 Report Alarm Status

Opt

Opt

Opt Transaction

Actor

Alarm Communication Management Profile

Alarm Communication Management Profile

• Clinical Objective:– Improve clinical efficiency by using technology to

deliver the right alarms, with the right priority, to the right individuals via devices with the right content, and through configuration escalating communication of alarms to devices associated with other individuals

• Technical Objective: – Provide uniform way of representing common alarm

conditions to facilitate interoperability of systems from different vendors

• Clinical Objective:– Improve clinical efficiency by using technology to

deliver the right alarms, with the right priority, to the right individuals via devices with the right content, and through configuration escalating communication of alarms to devices associated with other individuals

• Technical Objective: – Provide uniform way of representing common alarm

conditions to facilitate interoperability of systems from different vendors

AlarmSource

AlarmAggregator

AlarmReceiver

AlarmCoordinator

AlarmDisseminator

AlarmCommunication

AlarmEndpoint

AlarmCommunicator

(AC)

AlarmManager

(AM)

AlarmReporter

(AR)

AlarmReporter

AlarmCache

Alarm Archiver(AA)

Communication detailed in this profile

Communication not detailed in this profile

.

.

.

.

.

.

The intended use is to serve in communication of alarm information from patient care devices to an alarm manager system communicating with secondary means of notification to caregivers. Typical secondary notification means would be annunciators, pagers, and smart phones. *Note that in 2009 this profile is being extended to other alarms including from systems such as patient/asset tracking, bed management, etc

Use CasesUse Cases

• Case A1: Location Sourced alarm (i.e. nurse call type alarms)

• Case A2: Identified Patient Source (i.e. physiological type alarms)

• Case A3: Same as A1/A2 with Escalation and Cancel at Alarm Reporter (AR)

• Case A4: Same as A1/A2 with Escalation and Cancel at Communication Endpoint

• Case A5: Same as A1/A2 with Escalation and Cancel at Alarm Manager (AM)

• Case A6: Alarm with no destination other than logging by the Alarm Manager (AM) actor

• Case A1: Location Sourced alarm (i.e. nurse call type alarms)

• Case A2: Identified Patient Source (i.e. physiological type alarms)

• Case A3: Same as A1/A2 with Escalation and Cancel at Alarm Reporter (AR)

• Case A4: Same as A1/A2 with Escalation and Cancel at Communication Endpoint

• Case A5: Same as A1/A2 with Escalation and Cancel at Alarm Manager (AM)

• Case A6: Alarm with no destination other than logging by the Alarm Manager (AM) actor

Case A1: Location SourcedCase A1: Location Sourced

Patient wants a pillowPatient pulls nurse callNurse call system lights the room’s dome light and light at central station. Nurse call system, operating as an Alarm Reporter (AR) actor sends Report Alarm

[PCD-04] to Alarm Manager (AM) indicating nurse call alarm. The Alarm Manager (AM) logs receipt of the alarm. The Alarm Manager (AM)

identifies the appropriate nurse based upon configured nurse to patient assignments, identifies the appropriate Alarm Communicator (AC) actor and destination communication device based upon nurse to device configuration in Alarm Manager (AM), sends Disseminate Alarm [PCD-06] to nurse’s communication device. The Alarm Manager (AM) logs the dissemination to the Alarm Communicator (AC).

The nurse receives the alarm on their assigned device. The information minimally includes the patient location (room number). The nurse goes to the room, determines the needs of the patient, and provides the patient with a pillow. The nurse then resets the nurse call pull. The nurse call system turns off the room’s dome light and the light at the central station.

The nurse call system, operating as an Alarm Reporter (AR) actor sends Report Alarm [PCD-04] to Alarm Manager (AM) indicating reset of the nurse call alarm. The Alarm Manager (AM) receives the alarm turns off any configured alarm escalation and logs the alarm.

Patient wants a pillowPatient pulls nurse callNurse call system lights the room’s dome light and light at central station. Nurse call system, operating as an Alarm Reporter (AR) actor sends Report Alarm

[PCD-04] to Alarm Manager (AM) indicating nurse call alarm. The Alarm Manager (AM) logs receipt of the alarm. The Alarm Manager (AM)

identifies the appropriate nurse based upon configured nurse to patient assignments, identifies the appropriate Alarm Communicator (AC) actor and destination communication device based upon nurse to device configuration in Alarm Manager (AM), sends Disseminate Alarm [PCD-06] to nurse’s communication device. The Alarm Manager (AM) logs the dissemination to the Alarm Communicator (AC).

The nurse receives the alarm on their assigned device. The information minimally includes the patient location (room number). The nurse goes to the room, determines the needs of the patient, and provides the patient with a pillow. The nurse then resets the nurse call pull. The nurse call system turns off the room’s dome light and the light at the central station.

The nurse call system, operating as an Alarm Reporter (AR) actor sends Report Alarm [PCD-04] to Alarm Manager (AM) indicating reset of the nurse call alarm. The Alarm Manager (AM) receives the alarm turns off any configured alarm escalation and logs the alarm.

AR -> AM

AM -> AC

AC -> Nurse

AR -> AM

AR

PCD-04 Report Alarm

AM

PCD-06 Disseminate Alarm

AC

PCD-05 Report Alarm Status

PCD-07 Report Dissemination Alarm Status

PCD-05 Report Alarm Status

Opt

Opt

Opt

Alarm Reporter-Nurse Call-Medical Devices -Physio Monitors -Pumps -Apnea-Bedboard System

Alarm Manager-”Smart” alarm systems-Alarm aggregators

Alarm Communicator-Vocera-Cisco Wireless IP Phone-Cell Phone-Pager

How to askHow to ask

• The device shall support the IHE Alarm Communication Management (ACM) Integration Profile as the Alarm Reporter (AR) actor

• The alarm aggregator shall support the IHE Alarm Communication Management (ACM) Integration Profile as the Alarm Manager (AM) actor

• The device shall support the IHE Alarm Communication Management (ACM) Integration Profile as the Alarm Reporter (AR) actor

• The alarm aggregator shall support the IHE Alarm Communication Management (ACM) Integration Profile as the Alarm Manager (AM) actor

IHE PCD ProfilesIHE PCD ProfilesExisting Profiles

• Device Enterprise Communication (DEC)• Patient Identity Binding to Device Data (PIB)• Subscribe to Patient Data (SPD)

• Rosetta Terminology Management Project (RTM)• Alarm Communication Management (ACM)• Infusion Pump Integration (PIV) • Implanted Cardiac Devices (IDCO)

Works in Progress• Waveform Communication Management (WCM)• Medical Equipment Management (MEM)• Device Point-of-Care Integration (DPI, a multiyear effort)• Real-time data archiving and communication

Existing Profiles• Device Enterprise Communication (DEC)

• Patient Identity Binding to Device Data (PIB)• Subscribe to Patient Data (SPD)

• Rosetta Terminology Management Project (RTM)• Alarm Communication Management (ACM)• Infusion Pump Integration (PIV) • Implanted Cardiac Devices (IDCO)

Works in Progress• Waveform Communication Management (WCM)• Medical Equipment Management (MEM)• Device Point-of-Care Integration (DPI, a multiyear effort)• Real-time data archiving and communication

Leveraging IHE for purchasingLeveraging IHE for purchasing

• How do you get IHE Integration Profiles? – Specify IHE capabilities as requirements – State in the RFP which IHE Actors and Integration

Profiles you want.

• What do IHE Integration Profiles cost?– Nothing in most cases– Any cost should be a fraction of the overall

• How do you get IHE Integration Profiles? – Specify IHE capabilities as requirements – State in the RFP which IHE Actors and Integration

Profiles you want.

• What do IHE Integration Profiles cost?– Nothing in most cases– Any cost should be a fraction of the overall

The business case for implementing IHE Profiles

The business case for implementing IHE Profiles

• Enables you to efficiently manage the array of integrated information systems necessary to support effective healthcare

• The alternative– Building site-specific interfaces

• More expensive• Requires maintaining these custom interfaces for the life

of the system involved. • Integration via IHE is less costly at the start and makes

future acquisitions easier to plan and execute• IHE Profiles give clear definitions of how the pieces fit

together • IHE Profiles come with initial unit testing done

• Enables you to efficiently manage the array of integrated information systems necessary to support effective healthcare

• The alternative– Building site-specific interfaces

• More expensive• Requires maintaining these custom interfaces for the life

of the system involved. • Integration via IHE is less costly at the start and makes

future acquisitions easier to plan and execute• IHE Profiles give clear definitions of how the pieces fit

together • IHE Profiles come with initial unit testing done

What Can You Do?What Can You Do?

• Plan, Evaluate, Purchase IHE Conforming Devices

• In continuing discussions with vendors – at all levels– Push IHE Interoperability

• Refer to lower deployment, maintenance costs– Encourage vendors’ active IHE participation

• Lower development, installation, support costs– Refer to profiles

• Leverage public and objective commitments

• In RFPs– Refer to profiles, Conformance Statements– Use Conformance Statements to “nail down” vendor’s

representations– Adopt very specific language

• Plan, Evaluate, Purchase IHE Conforming Devices

• In continuing discussions with vendors – at all levels– Push IHE Interoperability

• Refer to lower deployment, maintenance costs– Encourage vendors’ active IHE participation

• Lower development, installation, support costs– Refer to profiles

• Leverage public and objective commitments

• In RFPs– Refer to profiles, Conformance Statements– Use Conformance Statements to “nail down” vendor’s

representations– Adopt very specific language

Sample languageSample language

• “The device shall support the IHE Device Enterprise Communication (DEC) Integration Profile as the Device Observation Reporter (DOR) Actor.”

• “The device shall support the IHE Device Enterprise Communication (DEC) Integration Profile as the Patient Identity Binding (PIB) Actor.”

• “The pump shall support the IHE Point-of-Care Infusion Verification (PIV) Integration Profile as the Infusion Order Consumer (IOC) Actor.”

• “The device shall support the IHE Alarm Communication Management (ACM) Integration Profile as the Alarm Reporter (AR) Actor.”

• “The device shall support the IHE Device Enterprise Communication (DEC) Integration Profile as the Device Observation Reporter (DOR) Actor.”

• “The device shall support the IHE Device Enterprise Communication (DEC) Integration Profile as the Patient Identity Binding (PIB) Actor.”

• “The pump shall support the IHE Point-of-Care Infusion Verification (PIV) Integration Profile as the Infusion Order Consumer (IOC) Actor.”

• “The device shall support the IHE Alarm Communication Management (ACM) Integration Profile as the Alarm Reporter (AR) Actor.”

What else?What else?

• Leverage the work done within IHE even if your vendor doesn’t conform

• Use the IHE Technical Framework as a basis for interface requirements– EUI-64 unique device identification– Time synchronization– HL7 v2.6– Semantics– Rossetta Terminology Mapping

• Leverage the work done within IHE even if your vendor doesn’t conform

• Use the IHE Technical Framework as a basis for interface requirements– EUI-64 unique device identification– Time synchronization– HL7 v2.6– Semantics– Rossetta Terminology Mapping

Where to startWhere to start

• Connectathon Results– http://sumo.irisa.fr/con_result/– If you’re looking for Alarm Reporters just

see who has already passed connectathon

• Connectathon Results– http://sumo.irisa.fr/con_result/– If you’re looking for Alarm Reporters just

see who has already passed connectathon

Patient Care DevicesHIMSS Interoperability Showcase 2009

GE GE CentricityCentricity®®

PeriopPeriop AnesAnes..

Enterprise

DOC DOC

Patient Patient

LiveDataLiveDataOR OR ––

DashBoardDashBoardTMTM

DOR = Device Observation Reporter / DOC = Device Observation Consumer

AR = Alarm Reporter / AM = Alarm Manager; IOC = Infusion Order Consumer / IOP = Infusion Order Programmer

PDQ/PAMServer

PhilipsPhilipsIntelliVueIntelliVue

ClinicalClinicalInfo PortfolioInfo Portfolio

DOC

Patient MonitorPatient Monitor

DOR, AR

DOC

DraegerDraegerInnovianInnovian®® WebWeb

CapsuleCapsule

GE GE CentricityCentricity®®

EnterpriseEnterprise

DOC

LiveDataLiveDataAlert ManagerAlert Manager

HospiraHospiraVeriScanVeriScan

DOCIOP

EpicEpicInPatientInPatient

EMREMR

DOC

EpicEpicInPatientInPatient

EMREMR

DOC

PhilipsPhilipsEmerginEmergin

AM

OR

TimeServerTime

Server

Step-DownICU

AM

Devices

CapsuleCapsuleDataCaptorDataCaptor

DOR,AR

Devices

CapsuleCapsuleDataCaptorDataCaptor

DOR,AR

PhilipsPhilipsIntelliVueIntelliVue

Info. CenterInfo. Center

AR DOR, AR

CernerCerner

CareMobileCareMobileTMTM

DOCIOP

EpicEpic

IOP

GEGECetricityCetricity®®EnterpriseEnterprise

IOP

AC

DOR

Hospital Bed

CernerCerner

CareAwareCareAwareTMTM

DOR

Hospital Bed

CernerCerner

CareAwareCareAwareTMTM

DOR,AR

InfusionDevices

IOC

B.

Bra

un

B.

Bra

un

Ho

spir

aH

osp

ira

Car

din

alC

ard

inal

DOR,AR

InfusionDevices

IOC

B.

Bra

un

B.

Bra

un

Ho

spir

aH

osp

ira

Car

din

alC

ard

inal

Patient Monitor,Ventilator

DOR

GEGEAwareAware

GatewayGateway

Patient Monitor,Ventilator

DOR

GEGEAwareAware

GatewayGateway

DOR,AR

InfusionDevices

IOC

B.

Bra

un

B.

Bra

un

Ho

spir

aH

osp

ira

Car

din

alC

ard

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DOR,AR

InfusionDevices

IOC

B.

Bra

un

B.

Bra

un

Ho

spir

aH

osp

ira

Car

din

alC

ard

inal

Patient Monitor,Anesthesia Sys

DOR, AR

DraegerDraegerInfinityInfinity

GatewayGateway

DOR,AR

InfusionDevices

B.

Bra

un

B.

Bra

un

Ho

spir

aH

osp

ira

Car

din

alC

ard

inal

DOR,AR

InfusionDevices

B.

Bra

un

B.

Bra

un

Ho

spir

aH

osp

ira

Car

din

alC

ard

inal

Patient Patient

PolycomPolycomWirelessWirelessPhonePhone

AlarmClient

CapsuleCapsule